Healthcare Provider Details

I. General information

NPI: 1861460487
Provider Name (Legal Business Name): CHERYL JEAN WHITMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 GALISTEO ST
SANTA FE NM
87505-2101
US

IV. Provider business mailing address

2025 GALISTEO ST
SANTA FE NM
87505-2101
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-4901
  • Fax: 505-989-6426
Mailing address:
  • Phone: 505-995-4901
  • Fax: 505-989-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number76-288
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: